Health Disparities Part II: Information, Obesity and Mental Illness

Part I of Health Disparities, we talked about the harmful effects of disparities like food deserts and the role they play in chronic health conditions. We address the gap in treatment between ethnic groups even when treated by the same providers. We detailed the enormous cost of ethnic and gender health disparities on the U.S. health care system. We wrote about improving overall quality of care and how this would eliminate disparities in care. Improvements in information technology, performance measurements, provider incentives and translating science into cures, were all discussed.

In part II, I want to first examine how we’re all disparaged in health because of the way information is disseminated throughout our society and discuss disparities associated with obesity and mental health.

A national survey reports that US adults search online for medical and health information before talking to a medical provider. Although, adults trust their medical provider more, they are doing more online research prior to their visit to see a doctor. This shift in consumer online medical information searches sets up potentials for disparaging health consumption. Consumers have been the target for pharmaceutical companies direct to consumer advertising campaigns for decades. Increasingly, entertainment and news programs have increased their discussions of health and illnesses as well.

Trust in sources of information appear to be divided by generations. Baby boomers are more trusting of their physicians. Younger generations trust in the single source is not as great. The major problem with information’s disparaging effects is that media sources tend to portray issues incompletely and/or marginalize certain issues. Popular media sources are not likely to facilitate understanding helpful to all populations and is likely to perpetuate social and political differences with regards to health concerns.

The mass media can influence health both at the personal and public levels. The media can provide information that stimulate changes in health related attitudes and behaviors, both positive and negative. Mass media can raise awareness of health concerns among elected officials, contributing to changes. The influence of the media can produce intended outcomes like health education campaigns, however they can produce unintended consequences like unfavorable behaviors portrayed by entertainment personalities. The absolute worst outcomes are when media sources perpetuate stereotypes causing deeper schisms in attitudes. The popular Axiom; we’re susceptible to suggestions, 100% of the time.

In my article “Obesity Epidemic was Mis-Managed” discussed how the medical, fitness and food industry mis-managed the obesity epidemic in the US. This public health crisis affect approximately 65% of adults and 17% of young people in this country. We’re familiar with the physical illnesses related to the disease, but what we’ve heard little about is the mental health issues suffered by those who are overweight or obese. Americans who are overweight or obese are two to three times more likely to suffer serious mental illness. Obesity increases stigma and social isolation and reduces self-esteem. These conditions adversely affect quality of life, relationships, employment and integration into community life, all determinants of wellness.

Most mental health providers don’t offer obesity prevention or intervention strategies, even though they are a high risk population according to research. Furthermore, many of the pharmaceutical drugs used in treatment of mental health condition cause weight gain. Mental health providers have been operating under an assumption that weight loss interventions are ineffective for people with mental illnesses. This assumption has prevailed even in the face of recent research contradicting this belief.

According to a 2012 US News survey, 1 in 5 adults experienced some sort of mental illness in the prior year. The rate was twice a high for young adults between 18 and 25, than among those 50 and older. Women reported having a mental illness episode more than men. The survey defined mental illness as having a diagnosable mental, behavioral or emotional disorder. This survey revealed that 2 million adolescents between 12 and 17 reported a major depressive episode in the previous year. Those of us over 50 might be less inclined to seek treatment because of societal stereotypes, while we would be more aggressive in seeking treatment for a child or adolescent.

According to American Public Health Association, adults with mental illness are 70% more likely to smoke than those without an illness. JAMA Pediatrics report that young men and adolescent boys are more likely to consume and abuse harmful substances due to poor body image concerns.

While women are more like to self-report or seek treatment for a mental illness episode, the male culture of “man up” likely prevent the same type of open discussion. We live in a culture that promote thin as healthy and beautiful, regardless of gender. Health care and prevention practitioners need to work together in the spirit of quality care to improve the chances of diagnosing mental illnesses concerns regardless of gender.

Having worked in the fitness industry for over 20 years, most of my clients had body image issues. Concerns about body image comprise the bulk of members in health clubs through the country. Body image issues, whether a person is overweight or obese correlates negatively on the wellness scale. I’ve observed a number of situations that can easily go undetected by family, coworkers and society. I’m talking about the functionally depressed. These are individuals who outwardly appear to move about their daily lives without concern. However, once outside the public view they shut down and exhibit all classic signs and symptoms of depression. Male or female, body image issues complicate this psychological dysfunction because it further isolate these individuals.

Mental illness is a health disparity in this country because it is so under treated, funded and talked about. Of course it affects ethnic minorities and women at a higher rates due to under funding and access to care. However, men likely suffer from mental illnesses at a much rate than what is self-reported. The major problem with mental illness is that it intersects with every wellness determinant. For example, a person awareness of self, diet, physical fitness, stress management, family life, job satisfaction, relationships and environmental sensitivity. How can a person be considered healthy, when they suffer with mental dysfunctions.

We receive information pertaining to health and wellbeing from some type of media outlet. The information varies based on the source, right or wrong, complete or incomplete there are many ways of providing information. Mass media generally does a poor job with accuracy and completeness. In many cases health disparities persist because of the lack of truth telling by mass media. We simply need better story tellers.

Obesity is a disease, it is rooted in addictive behaviors. There are health consequences related to getting the story wrong. Information that marginalize populations suffering from this disease causes harm in society. Medical and mental health professional who do not stay up to date on the latest research and hide behind persistent stereotypical beliefs does the system of care harm.

The internet was supposed to facilitate information gathering and in many cases it does a great job. However, too often people only search for information which fit their particular belief system. For this reason, popular media is more likely to contribute mis understanding and perpetuate erroneous health information. Rather than being a source which provide clear understanding of the latest researched data.

Those of us involved in education must persist to provide information to shine a light where the system has failed. When we get it wrong, we can’t marginalize our failure. Instead it’s important that we tell that story as well, only be doing so can we create credibility. Most of what we think we know today about medicine, fitness, mental illness and wellness is not likely to withstand the passage of time. New research hopefully with debunk all our current hypothesis. Disparities persist because of a lack of truth tellers, not a lack of information. To be continued…